One of the conditions that I often treat as an integrative gastroenterologist is gastroparesis. So, what is it? Well, gastroparesis basically means slow emptying of the stomach. Essentially, the stomach doesn't work as well as it should and food isn't processed as quickly as it should be, and as a result, food doesn't leave the stomach at the right pace. Some of the symptoms that someone with gastroparesis might feel could include upper abdominal pain, bloating, nausea, vomiting, fullness, early satiety, belching, and in some cases even regurgitation.

What is gastroparesis?

Gastroparesis is considered a motility disorder. This is kind of a fancy medical way of saying something doesn't move fast enough…in this case, it's your stomach. The key thing to make sure is established is that there is no physical or mechanical obstruction. For example, if your stomach doesn't empty well because you have cancer in your stomach and it's blocking the exit of food from the stomach, that would explain your gastroparesis-like symptoms. This is why it is very important to entertain this diagnosis under the care of a physician to ensure that the correct tests are done to make a solid diagnosis.

Causes of gastroparesis.

There are several different causes of gastroparesis. Interestingly, many cases of gastroparesis are idiopathic, which means we don't know exactly what causes them. Some of the more common known causes of gastroparesis include diabetes, spinal cord injury, stress, psychiatric disease, stroke, Parkinson's disease, multiple sclerosis, scleroderma, viral infections, autoimmune conditions, amyloidosis, and also medication-induced and post-surgical gastroparesis, One of the common underlying themes in some of these conditions is nerve or nervous-system-related dysfunction. In the case of diabetes, it is felt that chronically elevated blood sugars are associated with a higher risk of neuropathy. This oxidative stress and dysfunction of the nervous system are what contribute to the development of gastroparesis.

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How to know if you have gastroparesis.

If you have symptoms that could suggest gastroparesis, it's likely that you will be referred for an upper endoscopy. This is a procedure in which a gastroenterologist like me will insert a long flexible tube with a camera and light on the end of it into your mouth and into the upper gastrointestinal tract (you are sedated, of course!). The procedure involves evaluating the esophagus, stomach, and duodenum (the beginning portion of the small intestine). The primary purpose of this exam is to make sure that there isn't something else causing symptoms and to make sure there is no obstruction. If the exam is negative for any specific findings, you may be referred for a gastric emptying study. This is a test that is done in the radiology department, and they basically tag a meal with a radiolabeled isotope, you eat it in your food, and the radiologist can then determine what pace the food leaves the stomach, and if it doesn't empty fast enough, you could be diagnosed with gastroparesis.

Dietary changes for gastroparesis.

So, once you're diagnosed, then what? Well, if there's a particular cause identified, then treatment and management should be focused on the underlying cause in addition to the symptoms, not just the symptoms. Dietary modifications are at the core of any management strategy for gastroparesis. It's important to make sure fluids and electrolytes are balanced and blood sugar is controlled. It's suggested that people eat frequent small meals rather than two or three moderate-to-large meals a day, and some people may even need food blenderized.

Remember, this is all a matter of how much your stomach can take based on how fast it can move. If you try to fill your stomach faster than it can empty, then you're going to have a problem. So go slow and slowly fill up your stomach, giving the stomach more time (and less stress) to empty. The gastroparesis diet usually also entails meals that are low in fat and contain only soluble fiber. This is simply because it's easier for the stomach to process this type of diet. Fats are complex and harder to process, just as insoluble fibers are. If you make the job easier for the stomach, you will experience fewer symptoms. Hopefully, as your symptoms improve, you can liberalize your eating patterns and food choices. It can sometimes be helpful to work with a dietitian skilled in helping people with gastroparesis. Some people also consider food sensitivity testing to see if it might offer some insight into how they can optimize their dietary choices.

Medications for gastroparesis.

If dietary adjustments are not enough to control symptoms, then medications are sometimes used to help with gastroparesis. Metoclopramide, then domperidone, and then oral erythromycin (in that order) are the medications that can be tried, one after the other, to control gastroparesis symptoms. The big downer with these drugs is that they are not without side effects (for example, domperidone is not easily available in the United States and metoclopramide has a warning for a number of side effects including Parkinson's-like symptoms). It's important to discuss the potential side effects, particularly with long-term use, of these medications with your doctor. If none of these medications are unable to help, then a medication called cisapride could be considered as it has been shown to help with gastric emptying. However, this medication is also not readily available as it was voluntarily removed from the market in the United States over concerns for serious cardiac side effects.

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Integrative approaches to gastroparesis.

As an integrative gastroenterologist, however, I try to look beyond just these conventional approaches because there are definitely other things that we can do to help improve symptoms. Sure, we do need to keep these conventional algorithms and treatments in mind—especially when it comes to making a diagnosis—but there are things that can be done to improve symptoms outside of the conventional model. Ginger is one of my favorite herbs, and conveniently, it has properties to help with gastric emptying and gastrointestinal motility. STW-5 or iberogast is another therapy that includes a mixture of several different herbs and has been shown to effect intestinal electrophysiology. Swedish bitters have also been shown to have some efficacy in gastroparesis and so have acupuncture and electroacupuncture. Visceral manipulation massage, hypnosis, and music therapy may also be helpful adjunctive therapies to consider for gastroparesis.

Gastroparesis and the gut-brain connection.

Finally, it's really important to remember that there's a very well-documented mind-gut connection. The brain is directly connected to the gastrointestinal tract via the vagus nerve, which is a bidirectional information superhighway. Understanding the role of stress and emotion in modulating the motility of the gastrointestinal tract is a very important and often underappreciated concept. In my practice I often employ mindfulness, breathwork, and meditation as part of my treatment plan. We know that there is a brain-gut-microbiome axis and that the way the gastrointestinal tract works (or doesn't work) is influenced by all the messages and signals going back and forth all day long. It only makes sense that trying to take some initiative to modify some of the chemical messages going back and forth could help with underlying symptoms.

While gastroparesis may sound like a daunting diagnosis to get, there are definitely things that can be done to help your symptoms. Using a combination of conventional and integrative approaches may allow you to optimize the outcome and get your gut health back on track.

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